Type: Case report Title: Abscess caused by Citrobacter koseri ...

More documents

Recommendations

Info

elated to the discontinuation of antibiotics and, most importantly, the lack of drainage during the first admission. Instillation of antibiotic into abscesses does not improve the outcome in cases of Citrobacter infections. Different species of Citrobacter show different antimicrobial susceptibility profiles. These profiles should be referenced when choosing antibiotics to treat serious diseases. C. koseri is typically resistant to ampicillin but susceptible to aminoglycosides. In case 2, the initial undulating fever might have been due to a lack of direct drainage rather than β-lactam resistance. In C. koseri infection, aminoglycosides, carbapenems, fluoroquinolones, and third- or fourth-generation cephalosporins are considered effective, but some C. koseri strains may develop isolated resistance to β-lactams, aminoglycosides, and aztreonam (19). Thus, Shih et al. have proposed that a combination of β-lactams and aminoglycosides would be better at treating Citrobacter bacteremia than would a single agent (20). Until now, there has been no agreement on the use of monotherapy or combinations of antibiotics in treating Citrobacter abscesses. Empirical combination therapy would be appropriate in cases of shock, neutropenia, or nosocomial Citrobacter infections (21, 22). Doran stated that it would be proper to initiate treatment of neonatal brain abscess with direct aspiration or drainage followed by antibiotics for 4 to 6 weeks (23). Among the 12 patients listed in Table 1, all 10 cases of contracted community-acquired Citrobacter infections received direct drainage or surgical intervention and cephalosporins, aminoglycosides, fluoroquinolones, or β-lactams, alone or in combination. At the end of therapy, 11 cases resolved completely, and 1 resulted in death. Citrobacter species is not only a nosocomial pathogen but also a causative agent 8
of community-acquired infection. We have presented 3 cases to prompt a clinical alert to the possibility of C. koseri abscess, even in immunocompetent people. 9
Page 1 and 2: Type: Case report Title: Abscess ca
Page 3 and 4: Introduction Citrobacter species, b
Page 5 and 6: Culture of the aspirated pus reveal
Page 7: causative organism. Iliopsoas absce
Page 11 and 12: 11. Canario D, Reme P, Cunha B. Cit

Type: Case report Title: Abscess caused by Citrobacter koseri ...

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?